JOLIET – The Schultz family in Joliet struggled for months to find doctors who would care for them.
Kevin and Erin Schultz needed a doctor for their two daughters. Erin also needed a doctor for herself when she became pregnant in December, one who would monitor her closely because of past complications with giving birth.
But when their health insurance coverage changed under the state Affordable Care Act last fall, Kevin Schultz said they went through a nightmare ordeal with a new insurer that caused them to go through several doctors and limited their access to a local hospital.
The Schultz family is one of millions who have undergone changes in their health care after a 2010 federal law that requires citizens to obtain health insurance or face fines. Provisions of the law – which the public still is divided on, according to an August Kaiser Family Foundation poll – were enacted in 2013 to expand Medicaid coverage, as well as private insurance coverage, to more people.
The impact of the law has varied. In an April survey of 1,506 people from the Kaiser Family Foundation, a nonpartisan health policy organization, 56 percent reported no direct impact while 19 percent said it helped them and 22 percent said it hurt them.
The Schultz family is among those who said the law has made their health care coverage more than difficult. While they’ve been able to secure doctors for their children and Erin, who is due to give birth this month, the fight has left its mark.
“My children do have a decent pediatrician, but we’re talking about how long for a fight? This was almost a full year of fighting with insurance companies, fighting with doctors,” Kevin Schultz said.
Hunt for doctors
Kevin Schultz said his problems began in September 2014, when the state changed his family’s health insurance plan because of the Affordable Care Act. Previously, they were on Medicaid but now are required to receive that coverage through a private insurer, Erin Schultz said.
By December, Kevin Schultz wanted out.
He said the insurance company gave him a list of four doctors – in Joliet, Bolingbook and Lockport – to visit. Over the course of several months, he said he was unable to receive care from the first three doctors he visited – either because they didn’t exist, couldn’t accept his family as patients because of their insurance or because of the type of medical treatment they sought.
Under the Harmony Health Plan, the family was unable to receive care from Presence Saint Joseph Medical Center except for emergencies, he said. His wife could go there to give birth, but the insurance company told the family she would have to be moved to another hospital afterward.
The family lives less than a mile away from St. Joe’s.
When asked in an email questions about the family’s situation, a Harmony Health Plan spokesperson responded with a statement that “the company is committed to providing quality obstetrical [pregnancy] care” for its members.
“When a Harmony member indicates to us that she is unable to find a participating obstetrician-gynecologist in our network, Harmony contracts with an outside physician to ensure our member receives the care she needs,” the statement read.
Kevin Schultz said he was not able to find the help he needed from Harmony Health Plan to find a suitable doctor for his family until a person from the company was assigned – in July – specifically to them.
“We [complained] and moaned until we got somebody that knew what the hell they were doing,” he said.
It wasn’t until last January when he said he was able to find a pediatrician for his two daughters. Erin Schultz said until June she was unable to find a doctor who could give her the Level 2 ultrasound she needed as a high-risk patient because none of them would accept her insurance and she needed special authorization.
When asked about the option of visiting Will-Grundy Medical Clinic in Joliet, Kevin Schultz said he didn’t want to because he believes he would be directly billed. The clinic is a nonprofit organization that provides free medical and dental care to adults with no health insurance or medical care entitlements.
Kevin Schultz said he wasn’t able to free himself of Harmony Health Plan because he was told by the state he would be locked into that plan for a year. He said when his family received care through their previous Medicaid coverage, they had access to more doctors and hospitals than with Harmony Health Plan.
He wanted a different insurer in December and said he contacted the state Department of Human Services but they were unable to switch him. He also talked with other state department staff, to no avail.
The Schultz’s received help from the office staff of state Rep. Larry Walsh Jr., D-Elwood. Staff there put them in contact with the person at Harmony Health Plan who could better assist the family.
When asked about the family’s situation, Alissandra Calderon, Illinois Department of Insurance spokeswoman, wrote in an email that if a person was enrolled in a Health Insurance Marketplace plan, they would only be allowed to change plans during open enrollment period – unless they qualified for special enrollment. Erin Schultz said the family didn’t qualify for special enrollment because they already signed up for Harmony Health Plan.
Calderon wrote if the Schultz family was in a plan outside of the marketplace, they don’t “necessarily have open enrollment rights into plans. Therefore, they would want to wait until the Marketplace open enrollment.”
“However, the plan – whether on or off the Marketplace – should have a network to accept patients,” she wrote.
If a person is having problems, they should contact the state insurance department with a complaint.
The experience of being unable to pull away from Harmony Health Plan and receiving little help from the state has left Kevin Schultz bitter about the ACA.
Schultz said his wife and his children are at least receiving the medical care they need at this point, but the hoops he had to jump through have left him angry.
“It’s still not great but better than it was,” he said.